Following on from the entertaining and thought-provoking debate on preoperative blockade for phaeochromocytoma/paraganglioma during SfE BES 2021, this paper caught my eye.

Takeda et al. describe a case series of 68 patients undergoing a laparoscopic adrenalectomy for phaeochromocytoma, looking at haemodynamic instability (HDI; defined as systolic blood pressure ≥200 or <80mmHg). Out of 68 patients, 25 had HDI, with 19 patients requiring pressor use postoperatively. Factors associated with HDI were age, higher levels of metanephrines and the presence of diabetes mellitus. Diabetes mellitus was associated with postoperative pressor use.

The authors did not describe preoperative preparation being associated with HDI, although the regimens used were not the same as we might use in the UK. Nor was there a comment on preoperative filling or volume status.

These data suggest that it is not just the blockade the determines outcome. Patients with stiffer arteries that are less able to constrict when anaesthesia starts, or once the tumours are removed, may explain these findings in part. The study suggests that α and β blockade are not the only things to focus upon when preparing and managing patients perioperatively. As we all know, having a skilled anaesthetist is key, and maybe this is our learning point: a team approach with close working between endocrinologist, surgeon and anaesthetist should be top of our list for a successful surgical outcome.

Read the full article in Clinical Endocrinology 95 716–726